Healthcare Provider Details

I. General information

NPI: 1992146294
Provider Name (Legal Business Name): JULISSA RAYGOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39420 LIBERTY ST STE 140
FREMONT CA
94538-2289
US

IV. Provider business mailing address

39420 LIBERTY ST STE 140
FREMONT CA
94538-2289
US

V. Phone/Fax

Practice location:
  • Phone: 510-745-9151
  • Fax:
Mailing address:
  • Phone: 510-745-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: